MEDICARE: ULTRA IMAGING OF TAMPA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center
2	261QR0200X	Radiology Clinic/Center
3	261QR0206X	Mammography Clinic/Center

General Provider Information

NPI Number	:	1548267362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ULTRA IMAGING OF TAMPA, LLC

Provider Business Mailing Address
First Line	:	2137 WEST MARTIN LUTHER KING BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607
Country	:	US
Telephone Number	:	813-879-1674
Fax Number	:	813-846-6471

Provider Business Practice Location Address
First Line	:	2137 W MARTIN LUTHER KING BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607
Country	:	US
Telephone Number	:	813-879-1674
Fax Number	:	813-876-6471

Authorized Official
Title or Position	:	SENIOR VICE PRESIDENT
Name	:	MR. ROBERT SAMUEL HANKINS JR.
Credential	:
Telephone Number	:	615-344-2274

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	09/11/2025

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